Non-surgical systems used in skin aging and treatment (anti-aging)

The average life expectancy has increased from 22 years in ancient Rome, to 76 years in the 1980s, to 85 years today. This extended life span increases the time individuals spend productively in society.

What is skin aging? What are the factors affecting aging?

Aging is a process that develops differently in every human being with genes, in other words hereditary characteristics, environment and life styles. Our skin ages like all organs. The only difference is that everyone sees this process. The skin is the biggest organ of our body and the window that opens to the outside, at the same time the biggest indicator of our body health.

With skin aging, the number of cells, volume and functions of the skin decrease. This situation occurs at different rates in everyone. Skin aging is a complex, irreversible biological and chemical condition. Many factors play a role.. Skin aging can be divided into two. One is internal aging, which increases depending on time, and the other is aging due to external factors (photoaging). With this process, cell renewal, protective functions, oil production, vitamin D production, hair and nail growth are slowed down. The earliest signs of aging show themselves on the skin and it is the first place of observation that we refer to for age prediction.

In chronological, that is, internal aging, the skin becomes thinner, elasticity decreases, fine wrinkles occur and the word becomes deeper. This type of skin aging constitutes 20% of all aging and is inevitable.

Photoaging due to external factors constitutes 80% of skin aging. This medicine has the fortune to prevent and change aging. The most valuable of environmental factors is the sun. 50-75% of sun exposure occurs in the first 20 years of life with the formation of what is called free radicals.

What are the methods used in non-surgical approaches to prevent or correct skin aging?

Creams
Botox
fillers
Chemical peeling (skin peeling)
Laser applications

Creams:

The sun causes skin color changes, thickening and thinning, roughness, vascular enlargement, sagging and coarsening, wrinkles and skin cancer.

Estrogen plays a key role in maintaining the youthfulness of the skin. With the decrease of estrogen, the skin becomes thinner, its elasticity decreases, sagging and wrinkles increase. All these changes are due to the decrease in a protein structure called collagen in the skin. The most obvious loss of skin occurs in the first 2 years of menopause and continues with 30% reduction of collagen in the fifth year of menopause. Sun, smoking, tension, sleep disorder, alcohol use, malnutrition, weight changes, gravity, mimics are the most valuable factors affecting skin aging together with heredity. In this case, sun protection is the most valuable and cheapest “anti-aging” system in the prevention of skin aging.

What are the types and effects of sunscreens?
The negative effects of the sun on the skin depend on the time of exposure to the sun and the skin color and type.

Sunscreens are of two types, “chemical filters” and “physical sealers”. When physical sealants are applied to the skin, they often form a visible layer. They act by reflecting the sun’s rays. They are suitable for the protection of the facial area in infants and adults. Chemical filters, on the other hand, absorb (absorb) the sun’s rays and prevent them from reaching the bottom. These types of protectors are suitable for the protection of body skin. The numbers indicated on the sunscreens as SPF (Sun Protecting Factor) or GKF (Sun Protection Factor) indicate how much the sun exposure time increases.

SPF 15 protects from the sun 92%, SPF 30 94%, SPF 50 97%. In other words, very high protection factors are not required for protection from the sun. However, for this preservation, creams must be used under appropriate conditions.

These creams or lotions should be applied at least 20 minutes before going out in the sun and should be used adequately. To be truly effective, 2 mg/cm2 should be administered (30 ml for the whole body), repeated in the middle of 2 hours.

What is antioxidant? What is its importance in the treatment of skin aging?

Antioxidants are the elements that destroy the damaging effects of free radicals that are harmful to the body. Free radicals are the general name of the elements that are formed during the biological events that ensure the continuation of normal vital activities in our body, or under the influence of environmental factors such as cigarettes, air pollution and the sun, and damage the body cells. They disrupt the structure of cells and have a negative effect on many body systems and on the skin structure. Antioxidants destroy the damaging effects of free radicals. They can be produced by the body or taken from outside. With age, antioxidant production decreases and the body’s ability to destroy free radicals is also affected.

While free radicals play a valuable role in skin aging, antioxidants prevent the attack of free radicals.

We can list the antioxidants that are effective on the skin as follows:

Retinoids: They are derivatives of vitamin A. It smoothes the skin surface, opens fine wrinkles, lightens brown spots and plumps the skin. They should be used for at least 10-15 months to be effective. It is effective in skin aging due to both internal and external factors.
The effect of vitamin E (alpha tocopherol) is controversial.
Vitamin C repairs collagen damage and lightens the skin.
The effects of alpha lipoic acid and coenzyme Q10 have not been proven.
Green tea contains growth factors and increases cell regeneration.
Gingkobiloba, ginseng, aloe vera, seaweed, grape seed, wheat protein, soy protein, zinc and selenium do not have proven positive effects on skin aging.

What is Botox?

Botox is a toxin, a kind of poison, secreted by the bacterium Clostridium botulinum. Botulinum toxin-A (BTX-A) was first isolated in 1928 by Herman Sommer. In 1944, Dr. Purification studies were started by Edward Schantz et al., crystal form was obtained in 1946.

In 1949, Dr. The discovery by Vermon Brook that the toxin blocks the limits of movement forms the basis of its use in medicine.

BTX-A, which was first used in the treatment of strabismus in 1978, was discovered by chance. In 1987, ophthalmologist (ophthalmologist) Jean Carruthers observed improvement of frown lines in his patient, and shared this observation with his dermatologist wife, Alastair Carruthers.

Since 1990, BTX-A has been used successfully in the treatment of approximately 200 diseases such as strabismus, stuttering, migraine, swallowing difficulties, as well as the treatment of wrinkles caused by muscle contraction and excessive sweating.

What is the role of Botox in removing wrinkles?
Today, increasing life expectancy and prolonging life expectancy increase the amount of time individuals spend productively in society. The prolongation of the active period in professional and social life has an impact on people’s desire to look and feel more fit, healthy and young. This expectation increases significantly with the influence of written and visual media.

The area that most reflects the aging and wear process that begins with birth is our face. The facial area is the focus of rejuvenation processes. Although the surgeries defined with the aim of facial rejuvenation find an increasing number of applications, they are attempts that are hesitant because of the need for a beautification process, the scars they leave behind and the undesirable risks they carry.

For this reason, the popularity of easy attempts applied for both facial rejuvenation and changing facial features is increasing rapidly. BTX-A injections are the most applied formula all over the world since the first years of use.

Changes in bone, muscle, fat and skin tissue appear as the aging process and cause wrinkles as a symptom. Wrinkles that occur on the face are divided into two: Dynamic and Static Wrinkles.

Dynamic Wrinkles: These types of wrinkles appear as a result of the contraction of facial mimic muscles and they gradually increase from the age of 20. Their formation increases depending on the person’s mimic-making features and turns into static wrinkles with the permanent changes they create over time.

The most obvious of the dynamic wrinkles are horizontal lines on the forehead, frown lines in the middle of the eyebrows and crow’s feet at the corners of the eyes.

Since muscle activity is responsible for dynamic wrinkles, formulas such as BTX that change or stop muscle movements are successful in the treatment of this type of wrinkles.

Static Wrinkles: These are wrinkles that can be seen even when the face is at rest. They can become even more obvious with mimics compared to the place of residence. Laugh lines around the mouth and wrinkles on the lower eyelid known as the tear trough are the most common static wrinkles. BTX alone is not enough to correct static wrinkles. Soft tissue fillings or surgical methods are preferred.

How does Botox show its effect and how long does it last?

Botox stops the release of an element from the border ends and stops the movement of the muscle affected by that end. This effect starts slowly 2 days after the application, develops fully in the 2nd week and continues for 3 months. After the 3rd month, the issue that was stopped to be released starts to oscillate again and returns completely to the beginning in the 6th month.

As the total number of applications increases, the duration of clinical effect becomes longer. The effect around the eyes is often shorter than in other areas.

When the BTX injection is first started, after 3 applications every 3 months in a row, the desired cosmetic effect can be maintained with an application usually every 6 months.

Who should apply Botox?

Appropriate injection technique and success depend on adequate knowledge of the anatomical conditions and characteristics of the muscle structures in the application areas. The anatomy of the application site should definitely be known in detail by the practicing doctor, otherwise undesirable complications may be encountered.

While the main limits in determining injection points are reasonable, individual variations require judgment based on the individual muscle size, activity and condition of each patient to be analyzed in detail. The experience of the person who applies it will also increase his ingenuity.

Cleaning the area to be applied before the injection and applying cold reduces the side effects such as infection, bruising and pain.

Who is Botox not applied to?

Those who are allergic to a random component of the Botox preparation
Those with muscle disease
During pregnancy and lactation
Those with bleeding disorders
Those with an infection-inflammatory condition at the injection site
It should not be used in those who use certain drugs: Aminoglycoside, cyclosporine, D-penicillamine, muscle relaxants, quinine and calcium channel blockers, magnesium sulfate and lincosamide.
In addition, those who need to use facial expressions in their work life (eg actors and actresses, politicians) should avoid botox applications.

What should be considered after Botox application?

Water, make-up and cream should not be applied to the area for 2 hours following the application. After the application, horizontal position for 4 hours, air travel within 24 hours is not recommended.

After the application, working the applied muscles for 2 hours ensures an early onset of the effect.

What are the undesirable effects that may develop due to Botox application?

When Botox application is performed by a specialist physician who knows his job, he displays a very confident profile.

Since much lower doses are used in cosmetic applications compared to medical treatment applications, side effects are also less: Headache, flu-like symptoms, allergic reaction, eyebrow asymmetry, double vision, drooping eyelid, asymmetrical smile, dry eyes, pain, bruising. They are rare complications due to application defects.

What are Fill Features? How are applications made?

Filling issues are the issues that are used for the treatment of deep and superficial wrinkles and the loss of volume caused by aging or diseases under the skin, and are the issues that allow the lost volume to be regained by injecting it under the skin.

For many years, researchers and clinicians have been working to develop the ideal soft tissue filling element. The application of the first filling issue dates back more than 100 years. Paraffin injections were made for the first time as a filling issue, but the result was unsuccessful due to undesirable side effects, namely complications. In 1893, it was used for the first time with the target of filling the fat taken from the person (autologous fat transfer). In the following years, synthetic filling elements such as liquid silicone were tried, but they were abandoned due to undesirable side effects.

In the early 1970s, the first studies on injectable collagen started, and in 1984, collagen was approved as a filler issue.

Due to the tissue reactions and side effects seen in the permanent filling issues, which have been developed for many years, the application of these issues was quickly abandoned altogether.

In parallel with the increasing interest in filler elements and the developments in technology, great progress has been made in recent years in the development of fillers that are longer lasting, less reactive and create more volume.

How many types of fill considerations are there?

Natural filling elements (collagen and hyaluronic acid)
autologous oil
Liquid fillers (acrylamides and liquid silicone)
Non-absorbable microspheres (polymethylmethacrylate)
Particulate materials (calcium hydroxylapatite)
Permanent implants (polytetrafluoroethylene)
“Hyaluronic Acid” is one of the most commonly used fillers and has the least complications.

Hyaluronic Acid (HA)

It is the most widely applied filling issue, which is found under different names in our country’s market. Hyaluronic acid is an element found in the usual structure of the young and elastic subcutaneous matrix (tissue). It is found in the body at an average rate of 200 mg/kg. The body of a 70 kg adult contains an average of 14 g of HA. It is found in the connective tissue and skin of the body. It has a high water holding capacity and has valuable effects such as bulking, moisturizing and cell proliferation. With aging, there is a loss of HA in the skin and joints. It has been used for many years in joint diseases with intra-articular injections.

HA was first produced from animal origin in 1989, but its half-life was found to be less than 24 hours. Then, the HA produced from bacterial origin had to be stabilized by cross-linking. Different molecular size preparations of HA have been produced as a filler. Small molecule loaded preparations are applied superficially to correct fine wrinkles, while medium and large molecule loaded preparations are applied deeper and used to fill deep wrinkles.

Fillers containing HA produced with recombinant DNA technology (ie using special genetic methods) can be applied to any surface of soft tissues. The rate of undesirable side effects is very low and there is no toxic effect. They are successfully used in the grooves formed on the nose and cheek, in the depressions of the rim, wrinkles in the middle of the eyebrows, in the filling of the lips, in the correction of acne scars and incision marks. HA injections persist for 6-9 months.

Anesthesia can be provided quickly with creams before HA application. In recent years, pain during injection can be prevented by adding local anesthetic to HA preparations.

What is the Chemical Peeling Process?

The history of the process of peeling the skin (peeling), which is done to eliminate the stains and fine lines that appear on the skin as a result of the intersection of genes, environmental conditions and lifestyles, and to make them look younger, dates back to Cleopatra in ancient Egypt. Today, it is possible to go down to the desired depth with chemical methods. Peels are in a wide range from easy types that can be applied by the patient in the residence to deep peelings that are performed with a significant operation.

Before peeling, it is necessary to know very well the basic concepts in this issue, the types and selection of peeling, and the side effects that we do not want to have.

The chemical peeling process (peeling) creates a controlled damage on a part of the skin as a result of the application of one or more chemical (acidic and basic) spies on the skin, resulting in a younger and healthier appearance of the skin. The aim is to cause damage to the desired depth in the skin layers and to provide the treatment of unwanted spots, formations and fine wrinkles on the skin by taking advantage of wound beautification during repair. While the wound is getting better, a younger appearance is created with the epidermal repair and the formation of new dermal connective tissue.

Chemical peeling, according to the damage depth of the peeling solution; It is classified as very superficial, superficial, medium and deep.

The result of the transaction; Different in different solutions, it varies depending on the concentration of the solution used, at the expense of acidity, the time it stays on the skin, the application technique, the applied area, the number of layers of the acid used, the preparation of the skin beforehand, and some factors such as skin type.

A chemical solution can cause peeling at different depths, on different bases, in different individuals at the same concentration. During and after the process, the patient’s harmony, smoothing process, complication development rate and results vary according to the depth of chemical peeling.

In a successful chemical peeling process; There are many factors such as the appropriate patient selection, the characteristics of the peeling solution, the application technique, and the experience of the applying doctor.

Appropriate patient selection is valuable for ideal results. Before the process, the general health status of the patients, the drugs they use, smoking, past cosmetic processes, viral infections called herpes, keloid, that is, very thickened scar formation, should be questioned. Skin type (chronologically (in terms of time) and photoaging) should be evaluated and graded. The patient’s life style and expectations should be properly evaluated; should be informed in detail about the process to be applied, all the possibilities that may occur during the implementation, and what needs to be followed after the process.

Laser and Light Systems in Dermatology

The word “Laser” consists of the initials of the phrase Light Amplification by the Stimulated Emission of Radiation. Albert Einstein first introduced the theory of absorption of stimulated light in 1917 as a module of the quantum theory. About 40 years after this theory, scientists developed the laser in line with this view.

Theodore Maiman developed the ruby ​​laser, the first red color laser, in 1959. Later, Nedymium : Yytrium-Aluminum-Garnet (Nd-YAG) laser was developed by Johnson in 1961, Argon laser was developed by Bennet in 1962 and CO2 laser was developed by Patel in 1964.

In the laser system, the beam emanating from the light source is deposited in an obvious cavity, strengthened and directed to an obvious point. Laser light is a single-direction, single-phase, monochromatic light that travels parallel to each other without dispersion.

When the laser light is selectively absorbed in the tissue, the power of the beam turns into heat and provides an effect.

What are the Uses of Laser in Dermatology?

Laser in the treatment of vascular (vascular origin) structures: The aim of this type of laser is the tissue vessel wall. It is used in the treatment of sometimes congenital pink-red-purple colored spots that occur as a result of vascular expansion and proliferation. Argon laser, argon sourced tunable laser, copper vapor / bromide laser, Nd:YAG laser, KTP laser, krypton laser and pulsed dye lasers are effective in the treatment of such structures.

Laser in the treatment of pigmented (dark brown) spots: The purpose of this type of laser is melanin, which gives color to the skin. KTP laser, Q-switched alexandrite and diode lasers are effective in the treatment of such structures.

Laser in tattoo treatment: Q-switched ruby ​​and Q-switched Nd-YAG laser in blue and black tattoos; Q-switched ruby ​​and Q-switched alexandrite lasers are used for green tattoos, and KTP, pulsed dye laser and Nd:YAG laser are used for red tattoos.

Laser in epilation: The aim in this process is melanin, which gives color to the hair. In one phase of the hair growth cycle, it contains more melanin than the surrounding area. The laser applied in this period ensures the burning of the hair. Alexandrite, diode and Nd:YAG lasers and IPL are the most important lasers used for this purpose. Laser should be selected according to skin color, type and hair structure. The type of hair that each one is effective on is different.

Laser in skin resurfacing: Treatment of aged skin basically involves the treatment of the outer 200 mm of the skin. For this purpose, ablative CO2 and Er:YAG lasers are used to peel the skin. They are effective by removing the upper layers of the skin and allowing the skin to regenerate. In applications where collagenase and fibroplasia are stimulated without peeling the skin, Mid-IR Nd:YAG laser, Mir-IR diode laser, Er:Glass laser, Q-switched Nd:YAG laser, IPL and radio-frequency are used. They rejuvenate the skin by stimulating certain enzymes.

Who decides on the laser and who should apply it?

Lasers are devices that require expertise to use. Dermatology and Plastic Surgery specialists are the experts who know these structures best. Selecting and applying the appropriate laser is not an easy process. It is unacceptable that the application is made by a person other than the doctor.

With the wrong selection and use of lasers, untreatable side effects (burns, scars and spots) may develop.

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